Marco Gambacciani

Abstract | CV

Abstract

PROGESTINS AND POSTMENOPAUSAL WELL-BEING

Gambacciani M, Department of Obstetrics and Gynecology “Piero Fioretti “, University of Pisa, Italy.

The issue of well-being and side effects has a great importance regarding the compliance to the postmenopausal hormone replacement therapy (HRT). Particularly, beneficial effects of estrogen replacement in relieving climacteric symptoms might be counteracted, at least in part, by the addition of a progestogen. Unpleasant effects of progestins depends on doses, type and route of administration. In addition, different women present different susceptibility to progestins effects mainly related to the effects of these different molecules on central nervous system. A trend to a progressive increase in body weight is often observed throughout the climacteric period. Perimenopausal women commonly correlate the increase in body weight with hormone use. Conversely, different lines of evidence suggest that menopause per se is related to an increase in body weight and to an android body fat distribution. Central body fat distribution has been associated to a series of endocrine and metabolic consequences related to an increased risk of cardiovascular disease. In prospective studies the pattern of body weight and body fat distribution were evaluated in the early postmenopausal period in women with and without HRT administration. Particularly the sequential combination of estradiol valerate (EV) with cyproterone acetate (CPA) (Climen ®, Shering) is effective in relieving subjective symptoms, preventing postmenopausal bone loss and the impairment of lipid profile that characterize the postmenopausal years. The EV+CPA preparation can blunt the increase in body weight, and prevent the shift to a more central, android fat distribution observed in normal women throughout their early postmenopausal period. In this view, the observed stabilization of body weight and body fat distribution can be seen also as positive action on woman’s body image and self-perception. However, CPA is a unique antiandrogen progestin, and the effects on body fat should be attributed to this specific replacement regimen or might be ascribed to all oral HRT. On the other hand, other lines of evidences clearly demonstrate that the continuous combined association of EV with the anti-androgenic progestin dienogest (Climodien, Schering), can induce improvements in symptoms, mood and depression, increasing the well-being of treated postmenopausal women. This particular combination increase subjective and objective sleep quality in postmenopausal women with a reduction of sleep-related breathing disorders as compared to pre-treatment and placebo. In addition , women treated with the EV+dienogest combination experienced an increase in vigilance, and an improvement of information processing speed and cognitive processing capacity, as compared to pre-treatment and placebo treated subjects. Different HRT preparations can be selected in different subjects according to their needs and preferences. In this view, the availability of different progestins will represent a major advance in climacteric medicine.

CV

Department of Obstetrics and Gynecology “Piero Fioretti”
Santa Chiara Hospital, University of Pisa, Via Roma 67, 56100 Pisa
Tel + 39-50-992385, Fax +30-50-553410
E-mail margamba@tin.it

Date of birth: April 5, 1954,
Education:1978 M.D., University of Pisa

Postdoctoral training:

1978-1982 Resident in Obstetrics and Gynecology, University Hospital, Pisa
1982-1984 Assistant in Research, Menopause Research Clinic and Endocrine Laboratory, Department of Obstetrics and Gynecology, University Hospital, Pisa
1984-1986 Postdoctoral Fellowship in Reproductive Endocrinology, Department of Reproductive Medicine, University of California, San Diego
Program Sponsor Samuel S.C.Yen., Professor and Director
1986 In-training Award of The Pacific Coast Fertility Society 
1987 to present Assistant Professor, Menopause Research Clinic
Department of Obstetrics and Gynecology, Santa Chiara Hospital, University of Pisa

Membership in International Professional Societies:

1984 International Menopause Society
1985 Endocrine Society
1985 Italian Menopause Society
1987 International Society of Gynecological Endocrinology
1988 Italian Society of Obstetrics and Gynecology
1989 North American Menopause Society

· Member of the Executive Committee of the International Menopause Society
· Member of the Executive Committee of the Italian Menopause Society
· Member of the Italian National Health Service Working Group for Menopause Guidelines 

He is author of over 70 papers published in International journals. 

Major Research Interests:

· Biology of the menopause and perimenopausal years
· Endometrial cancer : prevention and screening
· Osteoporosis screening and prevention